Patients with small cartilage problems or spurs around the ankle can benefit from arthroscopy. During the procedure, a pencil-sized camera and small instruments are inserted through a few half-inch incisions around the ankle to visualize and treat the problem. The patient usually goes home the day of surgery and can start some limited walking with the help of crutches within a few days.

References

J Bone Joint Surg Am. 2002 May;84-A(5):763-9.

Comment in:

J Bone Joint Surg Am. 2003 Jan;85-A(1):164; author reply 164-5.

Posterior ankle arthroscopy: an anatomic study.

Sitler DF, Amendola A, Bailey CS, Thain LM, Spouge A.

Fowler Kennedy Sport Medicine Clinic, Univeristy of Western Ontario, London, Canada. dsitler@nmscd.med.navy.mil

BACKGROUND: Ankle arthroscopy has generally been performed with use of anterior portals with the patient in the supine position. Little has been published on ankle arthroscopy performed with use of posterior portals, particularly with the patient in the prone position. The purpose of the present study was to evaluate the relative safety and efficacy of ankle arthroscopy with use of posterior portals with the limb in the prone position.

METHODS: Thirteen fresh-frozen cadaver specimens were used. Posterolateral and posteromedial portals were established. Arthroscopy was performed, and the extent of the talar dome that could be visualized was marked. Four-millimeter plastic cannulae were filled with oil and were placed in the portals for use as reference landmarks on magnetic resonance imaging studies. The proximity of the portal cannulae to the adjacent structures was measured on standard magnetic resonance images and then during careful dissection. The distances measured by dissection were compared with the measurements made on magnetic resonance images.

RESULTS: An average of 54% (range, 42% to 73%) of the talar dome could be visualized. The average distance between a cannula and adjacent anatomic structures after dissection was 3.2 mm (range, 0 to 8.9 mm) to the sural nerve, 4.8 mm (range, 0 to 11.0 mm) to the small saphenous vein, 6.4 mm (range, 0 to 16.2 mm) to the tibial nerve, 9.6 mm (range, 2.4 to 20.1 mm) to the posterior tibial artery, 17 mm (range, 19 to 31 mm) to the medial calcaneal nerve, and 2.7 mm (range, 0 to 11.2 mm) to the flexor hallucis longus tendon. The magnetic resonance images demonstrated very similar distances except in the case of the distance between the posteromedial cannula and the tibial nerve, which often was difficult to specifically identify on magnetic resonance imaging studies.

CONCLUSIONS: The findings of the present cadaveric study suggest that, with the patient in the prone position, arthroscopic equipment may be introduced into the posterior aspect of the ankle without gross injury to the posterior neurovascular structures. Limited clinical trials should be carried out to confirm this finding.

Arthroscopy. 1996 Oct;12(5):565-73.

Ankle arthroscopy: outcome in 79 consecutive patients.

Amendola A, Petrik J, Webster-Bogaert S.

London Health Sciences Center, Ontario, Canada.

Seventy-nine consecutive ankle arthroscopies were analyzed at a minimum 2-year follow-up to evaluate the risks and benefits of the procedure. All arthroscopies were performed over a 2-year period by a single surgeon using the same nonskeletal traction technique. Forty-four arthroscopies were performed for therapeutic reasons only, whereas 35 were performed for both diagnostic and therapeutic purposes. Clinical examination with visual analog scores were used for assessment preoperatively and postoperatively. The diagnoses were osteochondral lesions of the talus in 21; post-ankle fracture scarring in 14, osteoarthritis and chondromalacia in 11, anterior bony impingement in 14; anterolateral soft tissue impingement or synovitis in 15; miscellaneous diagnosis in 4. Overall, 63 of 79 patients benefited in some way from the procedure. There were diagnostic benefits in 27 of 35 (77%) of ankles in which the diagnosis was clarified by the arthroscopy. In those ankles in which the procedure was performed for therapeutic purposes only, 36 of 44 (82%) of the patients benefited. Those patients with an underlying diagnosis of osteoarthritis of the ankle, posttraumatic chondromalacia and arthrofibrosis, or who were on disability and worker's compensation benefits, had poor results, whereas patients with a localized osteochondral lesion of the talus, localized bony or soft tissue impingement, or localized lateral plica had the best results. There were three significant neurological complications from ankle arthroscopy in this series. Two patients developed a postoperative partial deep peroneal nerve neuropraxia, and one patient had superficial peroneal nerve irritation at the site of the anterolateral portal. Ankle arthroscopy appears to be a relatively low-risk procedure with substantial benefits, particularly in localized disease of the ankle joint. Skeletal distraction was not used in any of these cases.